Robotic Completion Radical Cholecystectomy with Fluorescence Guidance

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Minimally invasive surgery (MIS) offers benefits for hepatobiliary malignancies, including shorter hospital stays and faster recovery.
• Completing radical cholecystectomy for incidental gallbladder cancer via MIS can be difficult due to prior surgery and limited tactile feedback.
• Robotic platforms can address these MIS challenges.

Purpose of the Study:

• To demonstrate the utility of robotic surgery in overcoming limitations during completion radical cholecystectomy for gallbladder cancer.
• To highlight how robotic platforms facilitate safe and oncologically sound procedures.

Main Methods:

• Utilizing a robotic platform with versatile wristed instruments for enhanced visualization and lymphadenectomy.
• Employing fluorescence imaging with indocyanine green (ICG) for anatomical confirmation in reoperative fields.
• Leveraging ICG pharmacokinetics for fluorescence angiography and cholangiography.

Main Results:

• Robotic wristed instruments and visualization aid in thorough lymphadenectomy.
• ICG fluorescence imaging effectively confirms porta hepatis anatomy in challenging reoperative settings.
• The described techniques enable safe robotic completion radical cholecystectomy.

Conclusions:

• Robotic surgery provides solutions for complex MIS completion radical cholecystectomy.
• The combination of advanced instrumentation and fluorescence imaging ensures oncologic safety and positive perioperative results.